Arthritis remains the primary cause of disability in the United States. However, just because you have arthritis does not mean you will qualify for social security disability benefits. We have a comprehensive page on how persons with severe medical conditions can win disability benefits – and that obviously includes those with arthritis. As we explain, a “short-cut” path to disability benefits for certain conditions is to meet the criteria for that condition in the so-called “Listings”. This Listings represent common medical opinion about the severity of medical conditions: if the criteria in the Listing is present, the widely held belief in the medical community is that the condition is disabling.
The Listings have created confusion among the general public – many wrongfully believing that the Listings are the only path to securing disability benefits. As you might imagine, they represent the extreme for the medical condition concerned.
In fact, most receiving disability benefits for arthritis did not qualify for disability under the arthritis Listing. The arthritis Listing, however, is very important. In this blog post let’s explore what it means to “meet a listing” for approval of social security disability benefits based upon an inflammatory arthritis. (Last year we explored this subject as it pertains to Lupus. As I set out in that post, the so-called “Listings” are set out criterion for given illnesses that social security agrees if present entitle a person to disability benefits. They are criteria that medical experts have agreed are disabling. As you might imagine, they represent the severest forms of given illnesses, and the failure to meet a listing does NOT mean the disability claim will be denied. I like to think of the Listings as a short cut to a favorable decision, but they are not the only path to victory.
The Listing for “Inflammatory arthritis” can be broken down to the follow 4 “paths”:
| PATH 1 | PATH 2 | PATH 3 | PATH 4 |
|---|---|---|---|
| Persistent inflammation or persistent deformity of: 1. One or more major peripheral weight-bearing joints resulting in the inability to ambulate effectively OR 2. One or more major peripheral joints in each upper extremity resulting in the inability to perform fine and gross movements effectively. | Ankylosing spondylitis or other spondyloarthropathies, with: 1. Ankylosis (fixation) of the dorsolumbar or cervical spine as shown by appropriate medically acceptable imaging and measured on physical examination at 45° or more of flexion from the vertical position (zero degrees); OR 2. Ankylosis (fixation) of the dorsolumbar or cervical spine as shown by appropriate medically acceptable imaging and measured on physical examination at 30° or more of flexion (but less than 45°) measured from the vertical position (zero degrees), and involvement of two or more organs/body systems with one of the organs/body systems involved to at least a moderate level of severity. | Inflammation or deformity in one or more major peripheral joints with: 1. Involvement of two or more organs/body systems with one of the organs/body systems involved to at least a moderate level of severity; AND 2. At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss). | Repeated manifestations of inflammatory arthritis, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level: 1. Limitation of activities of daily living 2. Limitation in maintaining social functioning. 3. Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace. |
I have highlighted terms in red that are further defined in the regulations that are extremely important. The definition of “Inability to ambulate effectively” is defined in the regulations in some 250 words (we are dealing with the government, after all) but here is the essence: you must have “an extreme limitation of the ability to walk; i.e., an impairment(s) that interferes very seriously with the individual’s ability to independently initiate, sustain, or complete activities”.
The “Inability to perform fine and gross movements effectively” is defined as “an extreme loss of function of both upper extremities; i.e., an impairment(s) that interferes very seriously with the individual’s ability to independently initiate, sustain, or complete activities.”
And finally, a “marked level” of the limitations in path 4 is defined as follows:
“Marked limitation means that the signs and symptoms of your immune system disorder interfere seriously with your ability to function. Although we do not require the use of such a scale, “marked” would be the fourth point on a five-point scale consisting of no limitation, mild limitation, moderate limitation, marked limitation, and extreme limitation.”
Not exactly clear is it. See why you might need an experienced social security disability lawyer? But the ” take home” lesson for looking at the listing for Inflammatory Arthritis is this: it generally takes a very severe and advanced disease to qualify for social security disability via this listing. Modern, competent rheumatological treatment has dramatically reduced the incidence of actual structural joint damage due to arthritis. Path 4, with its emphasis on fatigue and malaise symptoms, however, is a more likely path to a listing-based arthritis claim victory because rheumatologist continue to be only partially successful in alleviating fatigue and malaise.